新型冠状病毒、非典型肺炎冠状病毒及中东呼吸综合征冠状病毒所致肺炎早期肺部CT表现异同：基于系统性回顾对比分析

陈旭; 张刚; 郝帅营; 白林; 陆菁菁

doi:10.24920/003727

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新型冠状病毒、非典型肺炎冠状病毒及中东呼吸综合征冠状病毒所致肺炎早期肺部CT表现异同：基于系统性回顾对比分析

中国医学科学杂志（英文版） 2020年35卷第3期页码：254-261

Original Article | Updated：2024-04-10

- 新型冠状病毒、非典型肺炎冠状病毒及中东呼吸综合征冠状病毒所致肺炎早期肺部CT表现异同：基于系统性回顾对比分析
- Affiliations：
  
  Department of Radiology, Beijing United Family Hospital, Beijing 100015, China
- Author bio：
  
  * Lin Bai, Tel: 86-13701364326, E-mail: bai.lin@ufh.com.cn;
  Jingjing Lu, Tel: 86-13501398512, E-mail:cjr.lujingjing@vip.163.com
- Funds：
- DOI：10.24920/003727
  中图分类号：
- 收稿日期：2020-02-29，
  
  网络出版日期：2020-09-30，
  
  纸质出版日期：2020-09-30
- Accepted：
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陈旭, 张刚, 郝帅营, 等. 新型冠状病毒、非典型肺炎冠状病毒及中东呼吸综合征冠状病毒所致肺炎早期肺部CT表现异同：基于系统性回顾对比分析[J]. 中国医学科学杂志（英文版）, 2020,35(3):254-261.

Chen Xu, Zhang Gang, Hao Shuaiying, et al. Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review[J]. Chinese medical sciences journal, 2020, 35(3): 254-261.
陈旭, 张刚, 郝帅营, 等. 新型冠状病毒、非典型肺炎冠状病毒及中东呼吸综合征冠状病毒所致肺炎早期肺部CT表现异同：基于系统性回顾对比分析[J]. 中国医学科学杂志（英文版）, 2020,35(3):254-261. DOI： 10.24920/003727.

Chen Xu, Zhang Gang, Hao Shuaiying, et al. Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review[J]. Chinese medical sciences journal, 2020, 35(3): 254-261. DOI： 10.24920/003727.

摘要

目的

利用系统性回顾分析对比由新型冠状病毒、非典型肺炎冠状病毒及中东呼吸综合征冠状病毒导致的3种病毒性肺炎早期肺部CT表现的相似性及差异性。

方法

运用电子数据库分别检索成人新型冠状病毒肺炎、非典型肺炎及中东呼吸综合征冠状病毒肺炎CT表现的研究论文及病例报道。文献质量及数据完整性依3位放射科医生所达成的共识进行评估。采用选票计数法纳入各组病例。3组肺炎患者早期胸部CT表现包括病变形态、分布及特殊影像学征象

数据分别提取并记录。利用SPSS 22.0对数据进行对比分析。

结果

本文共纳入24项研究

其中新型冠状病毒病10项、中东呼吸综合征5项以及严重急性呼吸系统综合症9项。纳入的CT检查分别为147、40及122例。对于3种肺炎的早期CT表现

3组间“混合磨玻璃影及实变”、“以磨玻璃影为主”或“以实变为主”的基本病变形态无明显差异（

=7.966

0.05）。对于“主要累及双肺下叶及胸膜下区”这一病变分布特征

3组间无显著差异（

=4.809

0.05）。新型冠状病毒肺炎早期病灶表现更为局限（

=23.509

0.05）。铺路石征（χ

=23.037

0.001）、机化性肺炎（

0.05）及胸腔积液（

0.001）在新型冠状病毒肺炎的比例明显低于另外两组。尽管纤维条索在全部3种病毒性肺炎中很少出现

但更多见于严重急性呼吸系统综合症（

=6.275

0.05）。对于其他影像学表现

只有中东呼吸综合征肺炎早期CT出现了树芽征、空洞

并且其小叶间隔增厚发生率较另外两种肺炎明显增加（

=22.412

0.05）。每组早期CT表现均未见气胸、纵隔气肿及淋巴结肿大。

结论

3种冠状病毒肺炎早期影像表现具有相似的基本病变特征

包括磨玻璃影及实变、双侧分布

特别是以双肺下叶及胸膜下区分布为主。新型冠状病毒肺炎早期炎症程度较轻

早期纤维化改变仅见于严重急性呼吸系统综合症。中东呼吸综合征具有更严重的炎性改变包括空洞及胸腔积液。这些差异可能提示每种冠状病毒肺炎具有其特殊的病理生理学进程。

Abstract

Objective

To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2 (COVID-19)

SARS-CoV (SARS) and MERS-CoV (MERS) using a systemic review.

Methods

Electronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19

SARS and MERS pneumonia respectively. Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists. Vote-counting method was employed to include cases of each group. Data of patients’ manifestations in early chest CT including lesion patterns

distribution of lesions and specific imaging signs for the three groups were extracted and recorded. Data were compared and analyzed using SPSS 22.0.

Results

A total of 24 studies were included

composing of 10 studies of COVID-19

5 studies of MERS and 9 studies of SARS. The included CT exams were 147

and 122 respectively. For the early CT features of the 3 pneumonias

the basic lesion pattern with respect to “mixed ground glass opacity (GGO) and consolidation

GGO mainly

or consolidation mainly” was similar among the 3 groups (

=7.966

0.05). There were no significant differences on the lesion distribution (

=13.053

0.05) and predominate involvement of the subpleural area of bilateral lower lobes (

=4.809

0.05) among the 3 groups. The lesions appeared more focal in COVID-19 pneumonia at early phase (

=23.509

0.05). The proportions of crazy-paving pattern (

=23.037

0.001)

organizing pneumonia pattern (

0.05) and pleural effusions (

0.001) in COVID-19 pneumonia were significantly lower than the other two. Although rarely shown in the early CT findings of all three viral pneumonias

the fibrotic changes were more frequent in SARS than COVID-19 and MERS (

=6.275

0.05). For other imaging signs

only the MERS pneumonia demonstrated tree-in-buds

cavitation

and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia (

=22.412

0.05). No pneumothorax

pneumomediastinum and lymphadenopathy was present for each group.

Conclusions

Imaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns

including GGO and consolidation

bilateral distribution

and predominant involvement of the subpleural area and the lower lobes. Early signs of COVID-19 pneumonia showed less severity of inflammation. Early fibrotic changes appeared in SARS only. MERS had more severe inflammatory changes including cavitation and pleural effusion. The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.

关键词

Keywords

references

Wu F , Zhao S , Yu B , et al . A new coronavirus associated with human respiratory disease in China . Nature 2020 ; 579 ( 7798 ): 265 - 9 . doi: 10.1038/s41586-020-2008-3 10.1038/s41586-020-2008-3 . DOI: 10.1038/s41586-020-2008-3 http://doi.org/10.1038/s41586-020-2008-3 https://www.ncbi.nlm.nih.gov/pubmed/32015508 https://www.ncbi.nlm.nih.gov/pubmed/32015508

Huang C , Wang Y , Li X , et al . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China . Lancet 2020 ; 395 ( 10223 ): 497 - 506 . doi: 10.1016/S0140-6736(20)30183-5 10.1016/S0140-6736(20)30183-5 . DOI: 10.1016/S0140-6736(20)30183-5 http://doi.org/10.1016/S0140-6736(20)30183-5 https://www.ncbi.nlm.nih.gov/pubmed/31986264 https://www.ncbi.nlm.nih.gov/pubmed/31986264

Ajlan AM . Reply to “Chest CT findings in MERS” . AJR Am J Roentgenol 2015 ; 204 ( 1 ): W112 . doi: 10.2214/AJR.14.13367 10.2214/AJR.14.13367 . DOI: 10.2214/AJR.14.13367 http://doi.org/10.2214/AJR.14.13367 https://www.ncbi.nlm.nih.gov/pubmed/25539266 https://www.ncbi.nlm.nih.gov/pubmed/25539266

Xie X , Zhong Z , Zhao W , et al . Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing . Radiology 2020 ; 296 ( 2 ): E41 - E5 . doi: 10.1148/radiol.2020200343 10.1148/radiol.2020200343 . DOI: 10.1148/radiol.2020200343 http://doi.org/10.1148/radiol.2020200343 https://www.ncbi.nlm.nih.gov/pubmed/32049601 https://www.ncbi.nlm.nih.gov/pubmed/32049601

Lei J , Li J , Li X , et al . CT imaging of the 2019 novel coronavirus (2019-nCoV) pneumonia . Radiology 2020 ; 295 ( 1 ): 18 . doi: 10.1148/radiol.2020200236 10.1148/radiol.2020200236 . DOI: 10.1148/radiol.2020200236 http://doi.org/10.1148/radiol.2020200236 http://pubs.rsna.org/doi/10.1148/radiol.2020200236 http://pubs.rsna.org/doi/10.1148/radiol.2020200236

Fang Y , Zhang H , Xu Y , et al . CT manifestations of two cases of 2019 novel coronavirus (2019-nCoV) pneumonia . Radiology 2020 ; 295 ( 1 ): 208 - 9 . doi: 10.1148/radiol.2020200280 10.1148/radiol.2020200280 . https://www.ncbi.nlm.nih.gov/pubmed/32031481 https://www.ncbi.nlm.nih.gov/pubmed/32031481

Shi H , Han X , Zheng C . Evolution of CT manifestations in a patient recovered from 2019 novel coronavirus (2019-nCoV) pneumonia in Wuhan, China . Radiology 2020 ; 295 ( 1 ): 20 . doi: 10.1148/radiol.2020200269 10.1148/radiol.2020200269 .

Pan Y , Guan H , Zhou S , et al . Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China . Eur Radiol 2020 ; 30 ( 6 ): 3306 - 9 . doi: 10.1007/s00330-020-06731-x 10.1007/s00330-020-06731-x .

Lin X , Gong Z , Xiao Z , et al . Novel coronavirus pneumonia outbreak in 2019: computed tomographic findings in two cases . Korean J Radiol 2020 ; 21 ( 3 ): 365 - 8 . doi: 10.3348/kjr.2020.0078 10.3348/kjr.2020.0078 .

Fang Y , Zhang H , Xie J , et al . Sensitivity of chest CT for COVID-19: comparison to RT-PCR . Radiology 2020 ; 296 ( 2 ): E115 - E7 . doi: 10.1148/radiol.2020200432 10.1148/radiol.2020200432 . DOI: 10.1148/radiol.2020200432 http://doi.org/10.1148/radiol.2020200432 https://www.ncbi.nlm.nih.gov/pubmed/32073353 https://www.ncbi.nlm.nih.gov/pubmed/32073353

Pan F , Ye T , Sun P , et al . Time course of lung changes on chest CT during recovery from 2019 novel coronavirus (COVID-19) pneumonia . Radiology 2020 ; 295 ( 3 ): 715 - 21 . doi: 10.1148/radiol.2020200370 10.1148/radiol.2020200370 .

Duan YN , Qin J . Pre- and posttreatment chest CT findings: 2019 novel coronavirus (2019-nCoV) pneumonia . Radiology 2020 ; 295 ( 1 ): 21 . doi: 10.1148/radiol.2020200323 10.1148/radiol.2020200323 . https://www.ncbi.nlm.nih.gov/pubmed/32049602 https://www.ncbi.nlm.nih.gov/pubmed/32049602

Fang X , Zhao M , Li S , et al . Changes of CT findings in a 2019 novel coronavirus (2019-nCoV) pneumonia patient . QJM 2020 ; 113 ( 4 ): 271 - 2 . doi: 10.1093/qjmed/hcaa038 10.1093/qjmed/hcaa038 .

Shi H , Han X , Jiang N , et al . Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study . Lancet Infect Dis 2020 ; 20 ( 4 ): 425 - 34 . doi: 10.1016/S1473-3099(20)30086-4 10.1016/S1473-3099(20)30086-4 . DOI: 10.1016/S1473-3099(20)30086-4 http://doi.org/10.1016/S1473-3099(20)30086-4 https://www.ncbi.nlm.nih.gov/pubmed/32105637 https://www.ncbi.nlm.nih.gov/pubmed/32105637

Ren LL , Wang YM , Wu ZQ , et al . Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study . Chin Med J (Engl) 2020 ; 133 ( 9 ): 1015 - 24 . doi: 10.1097/CM9.0000000000000722 10.1097/CM9.0000000000000722 .

Liu J , Zheng X , Tong Q , et al . Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV . J Med Virol 2020 ; 92 ( 5 ): 491 - 4 . doi: 10.1002/jmv.25709 10.1002/jmv.25709 .

Xu Z , Shi L , Wang Y , et al . Pathological findings of COVID-19 associated with acute respiratory distress syndrome . Lancet Respir Med 2020 ; 8 ( 4 ): 420 - 2 . doi: 10.1016/S2213-2600(20)30076-X 10.1016/S2213-2600(20)30076-X . DOI: 10.1016/S2213-2600(20)30076-X http://doi.org/10.1016/S2213-2600(20)30076-X https://www.ncbi.nlm.nih.gov/pubmed/32085846 https://www.ncbi.nlm.nih.gov/pubmed/32085846

Koo HJ , Lim S , Choe J , et al . Radiographic and CT features of viral pneumonia . Radiographics 2018 ; 38 ( 3 ): 719 - 39 . doi: 10.1148/rg.2018170048 10.1148/rg.2018170048 . https://www.ncbi.nlm.nih.gov/pubmed/29757717 https://www.ncbi.nlm.nih.gov/pubmed/29757717

Chan MS , Chan IY , Fung KH , et al . High-resolution CT findings in patients with severe acute respiratory syndrome: a pattern-based approach . AJR Am J Roentgenol 2004 ; 182 ( 1 ): 49 - 56 . doi: 10.2214/ajr.182.1.1820049 10.2214/ajr.182.1.1820049 . https://www.ncbi.nlm.nih.gov/pubmed/14684511 https://www.ncbi.nlm.nih.gov/pubmed/14684511

Hansell DM , Bankier AA , MacMahon H , et al . Fleischner Society: glossary of terms for thoracic imaging . Radiology 2008 ; 246 ( 3 ): 697 - 722 . doi: 10.1148/radiol.2462070712 10.1148/radiol.2462070712 .

Ooi GC , Khong PL , Muller NL , et al . Severe acute respiratory syndrome: temporal lung changes at thin-section CT in 30 patients . Radiology 2004 ; 230 ( 3 ): 836 - 44 . doi: 10.1148/radiol.2303030853 10.1148/radiol.2303030853 . https://www.ncbi.nlm.nih.gov/pubmed/14990845 https://www.ncbi.nlm.nih.gov/pubmed/14990845

Das KM , Lee EY , Langer RD , et al . Middle East respiratory syndrome coronavirus: what does a radiologist need to know? AJR Am J Roentgenol 2016 ; 206 ( 6 ): 1193 - 201 . doi: 10.2214/AJR.15.15363 10.2214/AJR.15.15363 .

Choi WJ , Lee KN , Kang EJ , et al . Middle East respiratory syndrome-coronavirus infection: a case report of serial computed tomographic findings in a young male patient . Korean J Radiol 2016 ; 17 ( 1 ): 166 - 70 . doi: 10.3348/kjr.2016.17.1.166 10.3348/kjr.2016.17.1.166 .

Hamimi A . MERS-CoV: Middle East respiratory syndrome corona virus: can radiology be of help? Initial single center experience . Egyptian J Radiol Nucl Med 2015 ; 47 ( 1 ): 95 - 106 . doi: 10.1016/j.ejrnm.2015.11.004 10.1016/j.ejrnm.2015.11.004 .

Das KM , Lee EY , Singh R , et al . Follow-up chest radiographic findings in patients with MERS-CoV after recovery . Indian J Radiol Imaging 2017 ; 27 ( 3 ): 342 - 9 . doi: 10.4103/ijri.IJRI_469_16 10.4103/ijri.IJRI_469_16 . DOI: 10.4103/ijri.IJRI_469_16 http://doi.org/10.4103/ijri.IJRI_469_16 https://www.ncbi.nlm.nih.gov/pubmed/29089687 https://www.ncbi.nlm.nih.gov/pubmed/29089687

Zhao DW , Ma DQ , Wei W , et al . Early X-ray and CT appearances of severe acute respiratory syndrome an analysis of 28 cases . Chin Med J 2003 ; 116 ( 6 ): 823 - 6 .

Goh SK , Tsou YY , Kaw JL . Severe acute respiratory syndrome (SARS): imaging findings during the acute and recovery phases of disease . J Thorac Imaging 2003 ; 18 ( 3 ): 195 - 9 . doi: 10.1097/00005382-200307000-00010 10.1097/00005382-200307000-00010 . https://www.ncbi.nlm.nih.gov/pubmed/12867818 https://www.ncbi.nlm.nih.gov/pubmed/12867818

Nicolaou S , Al-Nakshabandi NA , Müller NL . SARS: imaging of severe acute respiratory syndrome . AJR Am J Roentgenol 2003 ; 180 ( 5 ): 1247 - 9 . doi: 10.2214/ajr.180.5.1801247 10.2214/ajr.180.5.1801247 . https://www.ncbi.nlm.nih.gov/pubmed/12704032 https://www.ncbi.nlm.nih.gov/pubmed/12704032

Wang R , Sun H , Song L , et al . Plain radiograph and CT features of 112 patients with SARS in acute stage . Beijing Da Xue Xue Bao Yi Xue Ban 2003 ; 35 ( Suppl ): 29 - 33 .

Müller N , Ooi G , Khong P , et al . Severe acute respiratory syndrome: radiographic and CT findings . AJR Am J Roentgenol 2003 ; 181 ( 1 ): 3 - 8 . DOI: 10.2214/ajr.181.1.1810003 http://doi.org/10.2214/ajr.181.1.1810003 https://www.ncbi.nlm.nih.gov/pubmed/12818821 https://www.ncbi.nlm.nih.gov/pubmed/12818821

Zeng QS , Chen L , Hu WQ , et al . Roentgenography and CT appearance in patients with severe acute respiratory syndrome . Zhonghua Jie He He Hu Xi Za Zhi 2003 ; 26 ( 6 ): 347 - 49 . https://www.ncbi.nlm.nih.gov/pubmed/12899767 https://www.ncbi.nlm.nih.gov/pubmed/12899767

Müller NL , Ooi GC , Khong PL , et al . High-resolution CT findings of severe acute respiratory syndrome at presentation and after admission . AJR Am J Roentgenol 2004 ; 182 ( 1 ): 39 - 44 . doi: 10.2214/ajr.182.1.1820039 10.2214/ajr.182.1.1820039 .

Chen H , Ai L , Lu H , et al . Clinical and imaging features of COVID-19 . Radiol Infect Dis 2020 ; 27 ( 2 ): 43 - 50 . doi: 10.1016/j.jrid.2020.04.003 10.1016/j.jrid.2020.04.003 .

Kim EA , Lee KS , Primack SL , et al . Viral pneumonias in adults: radiologic and pathologic findings . Radiographics 2002 ; 22 Spec No: S137 - 49 . doi: 10.1148/radiographics.22.suppl_1.g02oc15s137 10.1148/radiographics.22.suppl_1.g02oc15s137 . https://www.ncbi.nlm.nih.gov/pubmed/12376607 https://www.ncbi.nlm.nih.gov/pubmed/12376607

Wang C , Horby PW , Hayden FG , et al . A novel coronavirus outbreak of global health concern . Lancet 2020 ; 395 ( 10223 ): 470 - 3 . doi: 10.1016/S0140-6736(20)30185-9 10.1016/S0140-6736(20)30185-9 . https://www.ncbi.nlm.nih.gov/pubmed/31986257 https://www.ncbi.nlm.nih.gov/pubmed/31986257

Li Y , Xia L . Coronavirus Disease 2019 (COVID-19): role of chest CT in diagnosis and management . AJR Am J Roentgenol 2020 ; 214 ( 6 ): 1280 - 6 . doi: 10.2214/AJR.20.22954 10.2214/AJR.20.22954 . DOI: 10.2214/AJR.20.22954 http://doi.org/10.2214/AJR.20.22954 https://www.ncbi.nlm.nih.gov/pubmed/32130038 https://www.ncbi.nlm.nih.gov/pubmed/32130038

Wang CH , Liu CY , Wan YL , et al . Persistence of lung inflammation and lung cytokines with high-resolution CT abnormalities during recovery from SARS . Respir Res 2005 ; 6 ( 1 ): 42 . doi: 10.1186/1465-9921-6-42 10.1186/1465-9921-6-42 .

Chang YC , Yu CJ , Chang SC , et al . Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT . Radiology 2005 ; 236 ( 3 ): 1067 - 75 . doi: 10.1148/radiol.2363040958 10.1148/radiol.2363040958 . https://www.ncbi.nlm.nih.gov/pubmed/16055695 https://www.ncbi.nlm.nih.gov/pubmed/16055695

Xie L , Liu Y , Xiao Y , et al . Follow-up study on pulmonary function and lung radiographic changes in rehabilitating severe acute respiratory syndrome patients after discharge . Chest 2005 ; 127 ( 6 ): 2119 - 24 . doi: 10.1378/chest.127.6.2119 10.1378/chest.127.6.2119 . https://www.ncbi.nlm.nih.gov/pubmed/15947329 https://www.ncbi.nlm.nih.gov/pubmed/15947329

Alsaad KO , Hajeer AH , Al BM , et al . Histopathology of Middle East respiratory syndrome coronovirus (MERS-CoV) infection—clinicopathological and ultrastructural study . Histopathology 2018 ; 72 ( 3 ): 516 - 24 . doi: 10.1111/his.13379 10.1111/his.13379 . DOI: 10.1111/his.13379 http://doi.org/10.1111/his.13379 https://www.ncbi.nlm.nih.gov/pubmed/28858401 https://www.ncbi.nlm.nih.gov/pubmed/28858401

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